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GPHC 2016 Mock Registration Assessment Hudd. Ans. Pre-Reg Mock2016 Hudd Answers
GPHC 2016 Mock Registration Assessment Hudd. Ans. Pre-Reg Mock2016 Hudd Answers
5.
For questions with this icon, you may find the resource pack provided useful.
6. Electronic devices, such as personal calculators and mobile phones are not
permitted to be used in this part of the assessment.
7. You may use the blank spaces in this question paper for rough work. All question
papers, answer sheets and resource packs must be handed in at the end of part 2.
Print your name and pre-registration number here and sign to confirm that you have
read and understood these instructions and received a resource pack:
Name________________________________________________
Pre-registration trainee number____________________________
Signature_____________________________________________
1. A patient is given an intravenous dose of Drug X and his peak serum level is found to be 10
mg/litre. Given that 16 hours later his serum concentration is 2.5 mg/litre, which one of the
following is the elimination half-life of Drug X in this patient?
A.
B.
C.
D.
E.
2 hours
4 hours
6 hours
8 hours
10 hours
2. Mr OP is referred to you to review his medication in light of a recent fall where he sustained
a #NOF.
Which of his following medicines are likely to have caused the fall?
A.
B.
C.
D.
E.
Alendronic acid
Gliclazide
Metformin
Paracetamol
Prednisolone
3. Mr DP who suffers from schizophrenia and is well controlled by his antipsychotic developed
extrapyramidal side-effects. His consultant psychiatrist decides to prescribe procyclidine
and asks you to council Mr DP on the side-effects . Which of the following would you NOT
explain to Mr DP as a side-effect of procyclidine?
A.
B.
C.
D.
E.
Blurred vision
Constipation
Tachycardia
Dry mouth
Urinary retention
4. Mrs PF who suffers from heart failure has recently been admitted to hospital due to poor
symptom control. Her recent U&Es are as follows
Sodium
145 mmol/l (133-146)
Potassium 3.6 mmol /l (3.5 5.3)
Urea
9.2 mmol / l (2.5 7.8)
Creatinine 150 mmol / l (44 80)
On the ward she complains to you of nausea and her vision is a little blurred. Looking at the
observation chart you note her BP is 120/68 and pulse rate of 54. Which of the following
drugs she is prescribed is the most likely to be contributing to this clinical picture?
A.
B.
C.
D.
E.
6. Mrs BR brings in a prescription for carbimazole 15mg daily and tells you that her Dr had
done a blood test after she complained of palipatations and that her thyroid levels have
come back high. When you hand out the prescription which of the following side-effects do
you advise Mrs B report immediately?
A.
B.
C.
D.
E.
Alopecia
Bruising
Headache
Pruritis
Taste disturbance
7. Mrs GY visits your pharmacy complaining of a rash which starts centrally in the upper-left
region of her back, and follows a line around her body to the front, terminating just below
her left breast. She further informs you that there are one or two blisters present in this rash,
and that it is accompanied by an intense tingling sensation like "pins and needles". These
symptoms are typical of which one of the following conditions?
A.
B.
C.
D.
E.
eczema
impetigo
ring worm
rosacea
shingles
Stage 1
Select criteria to
review
Stage 2
Prepare for the
audit
Measure
performance
level
Prepare for the
audit
Make
improvements
Measure
performance
level
Select criteria to
review
Make
improvements
Select criteria to
review
Stage 3
Measure
performance
level
Select criteria to
review
Stage 4
Make
improvements
Stage 5
Sustain
improvements
Sustain
improvements
Select criteria to
review
Make
improvements
Sustain
improvements
Measure
performance
level
Measure
performance
level
Make
improvements
Sustain
improvements
Make
improvements
9. A neighbour, who is a very good friend of yours tells you she is worried about her pregnant
daughter-in-law who is in hospital having been admitted yesterday. She knows that you
work in the pharmacy there and asks if you can find out if she has had a miscarriage as
shes very concerned. Which of the following is the best course of action for you to take?
A. You want to help and offer to phone the ward as you know some of the staff quiet well
and say you will find out for her as soon as you can..
B. You say that you can check the patient records for her but only tell her if the lady is still
an inpatient or has gone home.
C. Tell her you dont work on the gynae. / ante natal unit so cant find out anything about
patients there.
D. Tell her how sorry you are but explain that there are strict rules about patient
confidentiality and you would not be able to share personal information that you had
access to at work.
E. Give her the phone number of the hospital and ward number and advise her to contact
the ward for the best information.
10. You arrive at work one morning to find an anxious lady waiting. Her child was discharged
from the hospital yesterday and had a bag of medicines supplied to take home. When she
arrived home there was an extra, unlabelled bottle of medicine in the bag and she is very
concerned a mistake has been made. She did not give any medicine from the unknown
bottle but is worried her child has missed something. On investigation the child has Sytron
dispensed correctly but the stock bottle has accidentally been put in the patients bag.
Which is the best of the following options?
A. You were not on duty yesterday and so you politely ask the lady to wait until another
member of staff arrives who was there the previous day as it will be better dealt with by
them.
B. You apologise and explain what has happened. You double check the rest of the
prescription and medicines with the lady and thank her for coming back. You explain
that you will investigate how the mistake occurred.
C. Childrens discharges are always checked on the ward with the parents and so you refer
her back to the ward for advice. You offer to phone the ward to check they are not too
busy to see her.
D. You take the discharge medicines from her and carefully store them for investigation.
You re-dispense the take home medicines and give the lady a complaint form to fill in so
that you have all the details.
E. You explain what has happened and say that you will make sure the person responsible
is made aware of the mistake but that its very unusual for such errors to occur. Theres
no harm done as the child hasnt had any and its not a dangerous medicine anyway.
11. It is a Saturday afternoon and a middle-aged gentleman approaches you to ask advice
about a rash very close to his eye. He has recently returned from abroad, the rash
developed a day or so ago and is sore and painful, as is his eye. You suspect that he may
have shingles. Which of the following would be the best course of action?
A.
B.
C.
D.
E.
12. Mr C has been diagnosed with H.pylori infection. He also takes ciclosporin 100mg BD for a
kidney transplant which he received 2 years ago. Which of the following H. pylori treatments
would be the best option for him?
A.
B.
C.
D.
E.
13. Mrs DP is currently taking Zomorph SR capsules 60mg BD and on average taking 10ml of
Oramorph solution 10mg / 5ml four times a day which is controlling her pain. She develops
swallowing difficulties and the GP wants to switch to fentanyl patches. Which of the
following strengths of fentanyl patch would you advise the GP to prescribe?
A.
B.
C.
D.
E.
12 microgram / hr
25 microgram / hr
50 microgram / hr
75 microgram / hr
100 microgram /hr
14. Whilst working in a busy community pharmacy and a patient arrives at the counter
requesting hydrocortisone 1% cream. Your counter assistant seeks your advice over the
sale. Which of the following patients presenting at the pharmacy would you authorise your
counter assistant to sell the hydrocortisone to?
A.
B.
C.
D.
E.
15. Mr MD has been commenced on Priadel 200mg daily for the treatment of bi-polar disorder
by a consultant psychiatrist. At the MDT the consultant asks you to counsel Mr MD on his
new treatment. Whilst discussing the timing of taking his medication in relation to the blood
tests needed to check his levels, which of the following number of hours do you advise Mr
MD to leave between taking his medication and having the blood test?
A.
B.
C.
D.
E.
4
6
8
10
12
Clinical Audit
Practice standards
Education and Training
Human Resources
Managing Risk
17. Which of the following statements is NOT true in relation to a Patient Information Leaflet?
A.
B.
C.
D.
E.
A PIL must include information about interactions with the medicine and food
A PIL must include information about contra-indications to the medicine
A PIL must include cost information about the medicinal product
A PIL must include advice about action to be taken if a dose is missed
A PIL must include information about common and less common side effects
150mg daily
200mg daily
250mg daily
300mg daily
350mg daily
20.
You have been provided with the Medicines for Children information leaflet for
cetirizine for hay fever. On collection of the prescription by Master Ms mother, she asks
you about common side-effects. Which of the following would you advise is a common
side-effect of cetirizine?
A.
B.
C.
D.
E.
Diplopia
Dysuria
Hypernatraemia
Paroxysmal excitation
Somnolence
21. Mrs EF is on holiday and has forgotten her phenobarbital tablets which she takes for
epilepsy and explains she is going home in a weeks time. How many days legally could
you supply to Mrs EF?
A.
B.
C.
D.
E.
None
Five
Seven
Twenty Eight
Thirty
22. Mrs BH, who is 63 years old was admitted to hospital following a fall on ice and suffered a
left #NOF. Her past medical history is hypertension and was controlled with felodipine
2.5mg daily and ramipril 5mg daily. Attached is a copy of her biochemistry results which
prior to admission were normal. Which of the following drugs started in hospital is the most
likely cause of Mrs BH's abnormal results?
A.
B.
C.
D.
E.
Codeine
Daltaparin
Flucloxacillin
Naproxen
Paracetamol
23. Mrs AG a 42 year old female is in hospital with an infection. The Dr prescribes an antibiotic
for this lady. Which one of the following antibiotics would you have to advise Mrs AG that it
may colour the urine orange-red?
A.
B.
C.
D.
E.
Amoxicillin
Ciprofloxacin
Metronidazole
Oxytetracycline
Rifampicin
Questions 24 to 28 relate to Mr BB a 54 year old male with hypertension, COPD and diabetes.
His latest prescription includes the following medication:
Amlodipine 5mg daily
Ramipril 10mg daily (acute Rx, previously 5mg daily)
Metformin 850mg twice daily
Salbutamol 100mcg 1-2 puffs when required
Tiotropium 18 micrograms daily
Seretide 500 accuhaler 1 dose twice a day
Amoxicillin 500mg three times a day for 7 days (acute Rx for LRTI)
Over the past 7 days, Mr BBs creatinine has increased from 107micromol/L to 325micromol/L.
His blood pressure is currently 141/85 mmHg, which has decreased from 156/91mmHg since
the modification of his antihypertensive medication doses by his GP 7 days ago (when the
above prescription was dispensed).
24. Which of the following is the most likely cause of his acute exacerbation of COPD?
A.
B.
C.
D.
E.
Chlamydia psittaci
Escherichia coli
Legionella pnuemophilia
Moraxella catarrhalis
Pseudomonas aerruginosa
25. Which of the following drugs is likely to explain his creatinine rise?
A.
B.
C.
D.
E.
Amlodipine
Amoxicillin
Metformin
Ramipril
Tiotropium
Amlodipine
Amoxicillin
Metformin
Seretide
Tiotropium
27. Had Mr BB been allergic to amoxicillin, which of the following would have been a suitable
alternative?
A.
B.
C.
D.
E.
Ampicillin
Cefradine
Ciprofloxacin
Doxycycline
Metronidazole
28. Mr BB has been complaining of a sore mouth for a few weeks, which of his following drugs
is the most likely to have caused this?
A.
B.
C.
D.
E.
Amlodipine
Metformin
Ramipril
Seretide
Tiotropium
29. Mr AF has been commenced on amiodarone in hospital for ventricular fibrilation. He comes
to you community pharmacy 2 weeks after discharge to get a further supply. He complains
that he is feeling tired and that his stools have changed from a dark brown to clay-coloured
and wonders if this could be caused by the amiodarone
What is the most appropriate advice for this patient?
A.
B.
C.
D.
E.
30. Mrs LT brings in her 4 year old son into the pharmacy, he has fallen off his bike and
sprained his wrist. She asks about a suitable pain killer for him and you decide to sell him
paracetamol. What dose do you advise Mrs LT to give?
A.
B.
C.
D.
E.
Questions 31 to 34 relate to Mrs RA a 72year old who has rheumatoid arthritis and is currently
on the following regimen.
Codeine 30mg 2 tablets four times a day
Amitriptyline 20mg at night
Methotrexate 15mg weekly
Folic acid 5mg every day except when taking methotrexate
Paracetamol 500mg tablets 2 tablets four times a day
Nefopam 30mg three times a day
Her daughter has noticed she has become confused over the last two days and that there is a
strong smell of urine in her bungalow. The doctor visits and diagnoses a UTI and prescribes
trimethoprim 200mg twice a day for 5 days
31. Which of the following bacteria is the most likely cause of the UTI?
A.
B.
C.
D.
E.
Bordatella pertussis
Chlamydia trachomatis
Escherichia coli
Haemophilus vaginalis
Staphylococcus aureus
32. Which of Mrs RA medication would you want to speak to the GP about regarding the
antibiotic prescription?
A.
B.
C.
D.
E.
Amitriptyline
Codeine
Folic acid
Methotrexate
Nefopam
33. Which of the following is NOT part of the methotrexate safe dispensing checklist
A. If dispensing a different strength this must be fully explained to the patient and the
number of tablets to be taken emphasised to avoid under or overdose
B. Differentiation between methotrexate and folic acid packaging. If patients receive
both medicines concurrently how can they distinguish between them
C. Beware patients attending with other symptoms; signs of methotrexate toxicity or
intolerance may present as for example sore throat or ulcers
D. Request sight of the patient-held recording document and check if any dose
changes have been made since last prescription issue
E. Assessment of need of individual patients; packaging, labelling and PIL requirements for
patients who may have reduced manual dexterity.
34. Which of the following antibiotics would be a suitable alternative to trimethoprim
A.
B.
C.
D.
E.
Amoxicillin
Cefalexin
Ciprofloxacin
Nitrofurantoin
Oxytetracycline
35. Which of the following antipsychotics would be suitable for a 24 year old male with an acute
psychotic episode
A.
B.
C.
D.
E.
36. Mrs RE brings in her 3 year old child and asks you if you could identify this rash. She
explains that he has not been feeling well for the past few days and has had a cold. Just
before the rash came out he had some white spots in his mouth.
Chicken pox
Measles
Meningitis
Rubella
Scarlet fever
37. Mrs RE (from Q36) requests a bottle of ibuprofen for her child. What dose do you
recommend she gives her 3 year old?
A.
B.
C.
D.
E.
38. Mr TH a 59 year old has just received his ambulatory blood pressure reading and his
average has come back at 152/94 mmHg. He has no other co-morbidities and does not
take any other drugs or have any allergies. His current U&Es are as follows
Sodium
145 mmol/l (133-146)
Potassium 3.9 mmol /l (3.5 5.3)
Urea
6.2 mmol / l (2.5 7.8)
Creatinine 50 mmol / l (44 80)
Which of the following would be an appropriate drug to start Mr TH for his hypertension?
A.
B.
C.
D.
E.
39.
Atenolol
Bendroflumethiazide
Candesartan
Doxazosin
Felodipine
You have been provided with the SPC for rivaroxaban (Xarelto) tablets.
Mr PE was admitted to hospital with chest pain and SOB which he has not experienced
before. He was diagnosed with a pulmonary embolism and his consultant on the post take
ward round decides to commence apixaban. He was assessed and his risk of bleeding
using the HASBLED chart showed the risk of bleeding outweighs the benefit of recurrent
pulmonary embolism. Following the ward round the FY1 asks you what dose to prescribe.
What is your recommendation?
A.
B.
C.
D.
E.
15mg twice a day for 21 days then 15mg daily to complete a 3 month course
20mg twice a day for 21 days then 15mg daily to complete a 3 month course
15mg twice a day to complete a 3 month course
20mg once a day to complete a 3 month course
15mg once a day to complete a 3 month course
40. Mrs B is a 34 year old female with a 1 year old child. She is suffering from depression and
has a diagnosis of bi-polar disorder. Which of the following would NOT normally be
recommended as a suitable treatment option as a mood stabiliser in this patient. She is
currently prescribed fluoxetine 20mg daily and zopiclone 3.75mg PRN
A.
B.
C.
D.
E.
Quetiapine
Valproate semi sodium
Olanzapine
Risperidone
Lamotrogine
41. A woman asks you to recommend a treatment for her 8-year-old son. She has noticed that
he has been scratching his bottom and she has also seen some cream-coloured thread-like
objects in his faeces. On questioning she tells you that her sons perianal skin is not broken
and that there are no signs of weeping. You also find out that he suffers from epilepsy and
takes carbamazepine but is otherwise well. Which one of the following non- prescription
products is it most appropriate for you to recommend?
A.
B.
C.
D.
E.
42. A flare-up of chronic eczema in an adult patient has failed to respond to betamethasone
valerate 0.25% cream. Which of the following alternatives would be the most appropriate to
consider prescribing next in a primary care setting?
A.
B.
C.
D.
E.
43. A 48-year-old female patient comes into A&E as she has inadvertently taken too many of
her theophylline tablets. Tests carried out immediately after the patient is admitted show a
peak theophylline serum concentration of 60mg/L.
How long will it take for the serum concentration to reach 7.5mg/L if they take no
further doses?
T0.5 for theophylline = 8 hours
A.
B.
C.
D.
E.
16 hours
24 hours
32 hours
40 hours
48 hours
8 hours
8 hours
8 hours
60mg/L-------------------30mg/L------------------15mg/L--------------------7.5mg/L
44. A terminally ill Mr RS is approaching end of life and is no longer taking anything by the oral
route. His current analgesia which is controlling his pain is tramadol 100mg QDS. He has
also been taking 5ml of oramorph 10mg /5ml approximately twice daily. The GP wants to
change this to diamorphine given by syringe driver over 24 hours. What dose do you
recommend?
A.
B.
C.
D.
E.
10mg
15mg
20mg
25mg
30mg
Co-amoxiclav tablets
Co-trimoxazole tablets
Doxycycline capsules
Erythromycin tablets
Vancomycin capsules
For the scenarios described, select the most suitable analgesic from the list above.
Each option may be used once, more than once or not at all
46. Which would be recommended only for 3 days use due to the risk of addiction?
H
47. Which would be the least appropriate solid dosage form analgesic for a vegan patient?
E
48. Which would be most appropriate for chronic back pain in an adult patient who is also taking
Priadel as a mood stabiliser?
F
49. Which would be most appropriate at a dose of 5ml QDS for an 18 month old patient with
Chickenpox?
B
50. A patient with gout asks you to sell them a treatment off-license as they are unable to
contact their GP Which analgesic is most likely to be implicated in this scenario?
G
Side effects
A. Bradycardia
B. Drowsiness
C. Haematuria
D. Hypertensive crisis
E. Myopathy
F. QT interval prolongation
G. Reduced eGFR
H. Sore throat
For the scenarios described, select the most suitable side effect from the list above.
Each option may be used once, more than once or not at all
51. Mr AS is started on sulfasalazine 1g four times a day for the initial treatment of Active
Crohns disease . Which of the ADRs listed does Mr AS need to be counselled about? H
52. Mrs OB is commenced on pioglitazone 15mg daily in addition to her metformin 1g three
times a day which she is tolerating well. You are dispensing pioglitazone for the first time.
Which of the ADRs listed on the slide do you need to make Mrs OB aware of? C
53. A 74 year old established on simvastatin 40mg at night, ramipril 5mg daily and atenolol
50mg daily is started on citalopram 10mg daily for depression. Which ADR listed on the
slide would you be concerned the patient may develop? F
54. Mrs TF takes co-beneldopa for her Parkinson's disease and has had her dose increased.
This however, has caused a problem with nausea for which her GP has commenced
domperidone. Which of the side-effects would you want to monitor for strongly? F
55. Mr VF has been commenced on warfarin for prevention of stroke and MI due to being
diagnosed with atrial fibrillation. Whilst counselling Mr VF, which of the side-effects would
you want to warn him to look out for? C
Cardiovascular drugs
A.
B.
C.
D.
E.
F.
G.
H.
Amiodarone
Bendroflumethiazide
Bisoprolol
Candesartan
Doxazosin
Lisinopril
Rivaroxaban
Ticagrelor
For the scenarios described, select the most suitable cardiovascular drug from the list
above. Each option may be used once, more than once or not at all
56. Which of the drugs listed would you need to advise the patient to take with food otherwise
approximately 30% of the dose is unavailable to the body? G
57. You are reviewing a patients medication as requested by falls team. You notice from the
recorded observations that your patient has significant postural hypotension. Which of the
drugs listed is the most likely to be responsible? E
58. You are in a community pharmacy and Mr DF who you know very well is talking to you
about his upcoming holiday to Florida. Which of the drugs listed above do you have to
remind him to use high protection sun cream to prevent against phototoxicity? A
59. Mrs BP comes into your pharmacy and requests a bottle of pholcodiene. Which of the
drugs listed above is the most likely to be responsible for this request? F
60. Which of the drugs listed above would you see commonly prescribed together with aspirin
for a period of 12 months? H
This is the end of the paper, now go back and check your
answers.